W. Va. Code R. § 69-9-12

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 69-9-12 - PHARMACOLOGICAL INTERVENTIONS

12.1. Pharmacological interventions used shall be those recognized as appropriate to treat neonatal abstinence syndrome in an inpatient community-based setting.

12.2. Medication, including over-the-counter medicine will be prescribed and monitored by a licensed physician, physician's assistant or advanced practice registered professional nurse.

12.3. Patients admitted to the facility with properly labeled and bottled medications may continue those medications with appropriate consents until the center obtains a current physician's order. At no time shall this period exceed 24 hours.

12.4. Only the person with prescriptive authority may order medications and dosages; only the program physician may approve changes in dosage.

12.5. The parent and/or legal representative shall be advised of any change in medication dosage or administration.

12.6. Each neonatal abstinence center shall have policies and procedures to comply with all relevant federal and state laws, rules and regulations regarding the storage, management and administration of medications kept at the facility. The policies and procedures shall include measures to:

12.6.a. Ensure responsible handling and secure storage of all medications kept at the facility;

12.6.b. Ensure responsible documentation of all medications received, stored, administered and dispensed at the facility;

12.6.c. Ensure only authorized personnel may access the storage areas where any medications are kept;

12.6.d. Ensure the security of medications to prevent diversion;

12.6.e. Ensure the proper recording keeping of all medications, including but not limited to, the:

12.6.e.1. Receipt of medication records;

12.6.e.2. Initial inventory;

12.6.e.3. Monthly inventory;

12.6.e.4. Counting of all controlled substances;

12.6.e.5. Perpetual logs;

12.6.e.6. Administration;

12.6.e.7. Documenting wastage;

12.6.e.8. Documentation of patient charts;

12.6.e.9. Disposal of controlled substances; and

12.6.e.10. Transferring of controlled substances among registrants.

12.6.f. Ensure all personnel administering medications to adhere to federal and state laws, rules, regulations, and protocols or guidelines from approved authorities;

12.6.g. Ensure medications are administered only by a practitioner who is qualified to do so by his or her scope of practice, is licensed under the appropriate state law, and is registered under the appropriate state and federal laws to administer opioid drugs; and

12.6.h. Ensure all medication is administered in accordance with its approved product labeling.

12.7. Medication Errors.

12.7.a. In the event of a medication error, a registered professional nurse shall:

12.7.a.1. Complete a physical assessment of the patient's condition;

12.7.a.2. Provide any and all first aid, and contact emergency medical services;

12.7.a.3. Place patient on cardio-respiratory monitor, if opiate error;

12.7.a.4. Notify the attending physician immediately;

12.7.a.5. Document and read back physician orders; and

12.7.a.6. Once patient is stable notify the Administrator, Director of Nursing, state protective services agency, and the state oversight agency.

12.7.b. Medication errors are considered a critical incident and must be reported to the state oversight agency.

12.8. Medication Storage and Handling.

12.8.a. Each and every time controlled substances change hands or are used, documentation must be generated and maintained at the center.

12.8.b. Controlled substance records shall be maintained according to chapter 60A, of the West Virginia Code.

12.8.c. Controlled substance records must be maintained at the center and must be readily retrievable and open to inspection and copying by the appropriate federal and state authorities.

12.8.d. The neonatal abstinence center shall conduct and submit a regular narcotics inventory and log review to the governing board on a quarterly basis.

12.8.e. On a regular monthly basis, and no longer than a 30 day interval, a narcotics log review shall be conducted by the Director of Nursing and one other professional staff member selected by the facility or the Governing Body.

12.8.f. The center shall provide training to all employees handling controlled substances in the proper procedures for storage and handling. This training shall be in accordance with the provisions of this rule.

12.8.g. All centers are required to have adequate controls in place to detect and prevent diversion of controlled substances.

12.8.h. All centers must follow proper storage requirements for ensuring security of medications, according to chapter 60A of the West Virginia Code, including but not limited to:

12.8.h.1. All controlled substances in a building must be stored in a permanently affixed, securely double locked and substantially built safe or cabinet;

12.8.h.2. The process or system for security of controlled substances must be commensurate with the quantity and types of controlled substances stocked; and

12.8.h.3. Controlled substances must not be left out or unattended at any time.

12.9. Handling Diversion, Loss and Theft.

12.9.a. A loss or theft must be immediately reported to the Drug Enforcement Administration, Board of Pharmacy, the West Virginia State Police, and the state oversight agency.

12.9.b. All reports of loss or theft must be completed on the required forms or methods as indicated by state and federal law, regulation or protocol.

12.9.c. All centers shall have a diversion control plan to address the prevention, intervention, investigation and quality control measures for the safeguarding of medications.

12.10. Administration of Narcotic Medications. When administering narcotic medication:

12.10.a. Two licensed nurses, one of which shall be a registered professional nurse, shall count the number of vials belonging to the patient;

12.10.b. The registered nurses shall remove the prescribed amount of the medication and record the remaining number of vials;

12.10.c. The unused (excess) amount shall be wasted and disposed of in accordance with state and federal law and within the provisions of this rule; and

12.10.d. Both licensed nurses shall sign the individual narcotic record book.

12.11. Medication Disposal.

12.11.a. Any medication that is unused, outdated, discontinued, expired or contaminated as wastage must be disposed of or destroyed according to local, state and federal laws and regulations.

12.11.b. When controlled substances are disposed of or destroyed, the following documentation must occur:

12.11.b.1. Log must have the center's name and address indicated;

12.11.b.2. Date of disposal or destruction;

12.11.b.3. Time of disposal or destruction;

12.11.b.4. Patient's name;

12.11.b.5. Drug name, drug dosage, and quantity disposed of or destroyed;

12.11.b.6. Reason for disposal or destruction;

12.11.b.7. Signature of the person, who shall be a licensed professional, preparing the report and performing the disposal or destruction; and

12.11.b.8. Signature of the witness, who shall be a licensed professional, as to the report and disposal or destruction.

12.11.c. Controlled substances must be disposed of or destroyed beyond reclamation.

12.11.d. All other medications shall be disposed of according to federal and state laws, regulations and protocols.

W. Va. Code R. § 69-9-12